CEO SUMMARY: Payers and health system administrators generally agree that healthcare is moving away from fee-for-service toward value-based payment. Because adoption of value-based contracts is slower for pathologists than for other providers, pathologists have the opportunity to define how provider systems can pay for value contributed by pathologists. However, to take advantage of this opportunity,
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Pathology groups face a number of challenging pathology trends in the era of radical healthcare reform.
One of the primary trends is that like clinical laboratories, these businesses are carrying significant and potentially unsustainable levels of unreimbursed services. Although bad debt and uncompensated care in the healthcare industry are not new, they have been increasing at the same time that downward pressure is being applied to pathology reimbursement.
Medical laboratories and pathology groups are also facing enormous levels of change in their clinical, regulatory and financial environments. As the Affordable Care Act is implemented, laboratories see downward pressure on reimbursement at both the federal and payer level, coupled with increased emphasis on efficiency and quality.
Labs and health care providers need to seriously consider moving toward a retail business model. Changes in the health insurance market are now requiring patients to pay more out of pocket, and the perfect storm of bad debt and decreased requirement is pressuring laboratories.
Other pathology trends include:
- Growing emphasis on the continuum of care
- Increasing patient interaction directly with the lab organization
- Mounting demands of interoperability across a proliferation of disparate information technology systems to achieve meaningful use
- Evolving requirements for communication and data sharing with payers, accountable care organizations (ACOs), health information exchanges (HIEs) and other trading partners
Industry observers say that responding to each of these trends requires access to the most complete set of patient data possible. Accurate patient identification and record consolidation is central to achieving these goals.
In addition, labs and pathologists are increasingly urged to add value to the testing services they perform by leveraging information technology. For instance, advanced health information technology can be deployed within clinical labs and pathology groups specifically to meet changing patient expectations, while supporting the needs of client physicians for optimal workflow.
HEALTHCARE BIG DATA IS ADVANCING in California and all pathologists in the Golden State will be required to submit data to the state’s cancer registry beginning in 2019.
California’s new law to support the state’s cancer registry is the latest example of an effort to ensure the timely collection of complete sets of data needed to
CEO SUMMARY: Advanced Pathology Associates, a 15-member private pathology group practice, had the distinction of generating data for the clinical study that Philips submitted to the Food and Drug Administration for review of its whole slide imaging system. Following the FDA’s decision to clear this system for sale earlier this month, and informed by their
CEO SUMMARY: Across the nation, pathologists are at a crossroads. Now that the FDA has cleared a digital pathology and whole slide imaging (WSI) system for use in primary diagnosis, should they adopt this technology sooner or wait until later? One pathologist who has worked with WSI for many years shared the lessons learned in
CEO SUMMARY: Among the three chief reasons for the merger of CellNetix and Puget Sound Institute of Pathology, the most compelling was the need to address the challenges in the current reimbursement environment and to prepare for reductions in payment to pathologists expected in the coming years under the Patient Access to Medicare Act. CellNetix
CEO SUMMARY: A 22-physician pathology group in Tampa has complied with rules for lab test ordering that UnitedHealthcare and BeaconLBS established, yet has experienced a steep decline in the volume of specimens it receives. Physicians told the pathologists that other labs were not using the BeaconLBS system or were not asking their clients to use
CEO SUMMARY: Once again, entrepreneur and pathologist David G. Bostwick, MD, is starting up a new lab company. Granger Diagnostics is now open and is located in North Chesterfield, Virginia. It is designed to be an anatomic, clinical, and molecular pathology reference laboratory. In an exclusive interview, Bostwick identified three substantial changes that have happened
CEO SUMMARY: It is one of those clinical laboratory deals that was announced before the end of 2015. Laboratory Corporation of America said it will acquire most of the operating assets of Pathology Inc., of Torrance, California, and that the acquired lab “will cease operations” upon the closing of the transaction. It has been six
CEO SUMMARY: Consultants in Laboratory Medicine of Greater Toledo was sold to Aurora Diagnostics last month. CLM’s president said that, as an ancillary service, pathology has little appeal to hospital administrators who want to cut costs as quickly as possible, and all hospital-based services are targets for cost reduction. Therefore, CLM sought a partner that
CEO SUMMARY: In a surprise move that further consolidates national anatomic pathology services, NeoGenomics will acquire Clarient Inc., from General Electric Healthcare. General Electric is getting cash, and preferred and common stock. The two companies announced plans to pursue integrated diagnostic services that would combine lab testing and diagnostic imaging data. The deal is subject